Recent research from the UK concludes that using a form of ultrasound in the treatment of prostate cancer is as effective as surgery or radiation therapy, but with fewer side effects. This research, coupled with the October 2015 approval by the FDA of a system that uses this type of ultrasound, is encouraging news for men diagnosed with localized prostate cancer.
Dr. Hugo Davila, MD, a urologist who has recently joined Florida Cancer Specialists’ Vero Beach and Sebastian offices, says the European data collected so far suggest ultrasound may be an effective treatment if the cancer is not considered to be “aggressive.”
The treatment is called high-intensity focused ultrasound (HIFU). It focuses ultrasound waves on the cancerous tissue, causing it to heat to about 200° Fahrenheit; this instantly kills the cancer cells without affecting healthy tissue. As it is a minimally invasive procedure, an overnight stay in the hospital is usually not needed. The recently-approved HIFU system is called the Sonablate 450 and was developed by SonaCare Medical, a company based in North Carolina.
The London study was led by University College Hospital. The researchers followed 625 men with localized prostate cancer who were treated solely with HIFU, which was approved in Europe in 1999. The results showed that 93 percent of the men were still cancer-free after five years. Less than 2 percent experienced long-term incontinence, and about 15 percent experienced erectile dysfunction. With surgery, the incidence of those distressing side effects is higher, though exact numbers are difficult to tabulate as definitions of the side effects vary.
Dr. Davila says data on the effectiveness of HIFU treatments will be collected by U.S. researchers in the next few years and, depending on the results, it may become a more standard practice. He says that there are no HIFU treatments currently available in the immediate area, but the method is in use at university hospitals in other parts of Florida. An Internet search shows that the Sylvester Comprehensive Cancer Center of the University of Miami Health System is among the first medical centers in the United States to offer HIFU as a treatment for prostate cancer.
The prostate is a small walnut-shaped gland that produces seminal fluid. It is estimated that there will be over 180,000 new cases of prostate cancer diagnosed in 2016, accounting for about 11 percent of all new cancer cases. According to recent data, approximately 14 percent of men will be diagnosed with prostate cancer during their lifetime. It’s a cancer that can be successfully treated, especially if detected early. Nearly 99 percent of men diagnosed with prostate cancer are still alive five years after diagnosis.
In its early stages, prostate cancer may not cause any signs or symptoms, so it’s important for men to discuss screening options with their doctor. More advanced prostate cancer may cause trouble urinating, decreased force in the urine stream, blood in the semen, discomfort in the pelvic area, and erectile dysfunction.
The type of treatment chosen depends on a number of factors unique to the individual patient, including his age and overall health, how fast the cancer is growing, if it is localized or has spread, and anticipated tolerance of potential side effects. Immediate treatment may not be necessary for men with very early-stage prostate cancer; doctors will sometimes recommend active surveillance, also known as “watchful waiting.”
Dr. Raul Storey, an oncologist with Florida Cancer Specialists, says he does not consider HIFU to be the first line of treatment when prostate cancer is diagnosed: “There are other FDA-approved treatment options that are well studied, with a great deal of long-term data about their effectiveness and side effects.”
Treatment options include:
• Radiation therapy, which uses high-powered energy to kill cancer cells. There is radiation that comes from outside the body (external beam radiation) and internal radiation (brachytherapy), in which rice-sized radioactive seeds are placed in the prostate tissue.
• Hormone therapy, including medications that either stop the body from producing testosterone or block testosterone from reaching cancer cells. Hormone therapy is often used to shrink the tumor, increasing the likelihood that radiation will be successful.
• Surgery, which involves removing the prostate gland (radical prostatectomy), some surrounding tissues and a few lymph nodes.
• Cryosurgery (also called cryoablation), in which small gas-filled needles are inserted into the prostate, alternatively freezing and thawing the tissue, killing cancer cells (and, unfortunately, some healthy tissue as well).
• Immunotherapy uses the body’s immune system to fight cancer cells. In 2010, the FDA approved an immunotherapy called sipuleucel-T (brand name Provenge) for the treatment of advanced, recurrent prostate cancer.
• Chemotherapy may be an option for prostate cancer that has spread to distant parts of the body, or which didn’t respond to hormone therapy.
While doctors are not sure what causes prostate cancer, the Mayo Clinic lists the following risk factors:
• Age. The risk of prostate cancer increases with age.
• Being black. Black men have a greater risk of prostate cancer than do men of other races. For reasons that are unclear, prostate cancer is also more likely to be aggressive or advanced in black men.
• Family history. Risk increases if there is a family history of prostate cancer, or of genes that increase the risk of breast cancer (BRCA1 or BRCA2).
• Obesity. Obese men diagnosed with prostate cancer may be more likely to have advanced disease, making it more difficult to treat.
Dr. Davila and Dr. Storey can be reached at Florida Cancer Specialists. The Vero office is located at 1880 37th St.; the phone number is 772-567-2332. The Sebastian location is 13060 US Highway 1, Suite A; the phone number is 772-589-0879. The website for Florida Cancer Specialists is www.flcancer.com.